PUMPING IRONY: Let Your Knees Be

My Lovely Wife and I spent the past week encamped on the North Shore of Lake Superior, a vacation experience that involves more walking around than our two pairs of knees tend to enjoy. It’s especially tough on MLW’s bum right knee, which has been supporting her sans cartilage since a well-intentioned surgeon removed all that cushioning nearly 40 years ago. It’s on these occasions that I marvel at her toughness, even as I begin to wonder whether it’s time to consider knee replacement or some other surgical fix.

It’s not that we haven’t considered it before. Several years ago, MLW even went so far as to consult with an orthopedic specialist, who took some x-rays and, while expressing some amazement that she was even walking on that knee, recommended that she get a new one right away. But MLW has always been quite attached to her right knee and was not persuaded. She instead discovered Feldenkreis and began practicing yoga — two approaches that focus on learning how to move more mindfully on the knees you were born with rather than simply discarding the offending joint.

This is not a common approach for older folks. Every year, about a million adults go under the knife in hopes of relieving their knee pain and recovering some or all of their previous mobility. But a couple of recent studies suggest that MLW is doing the right thing by avoiding doctors with sharp instruments.

Researchers at the Cincinnati Sports Medicine & Orthopedic Center tracked 38 patients who had the meniscus replaced in their knee and concluded after following their progress for 11 years that the procedure produced only mixed results. About three-fourths of the study subjects were able to participate in “low-impact” sports such as bicycling and swimming (both of which MLW and her bum knee currently enjoy), but even these minor surgical benefits don’t last. “The longer-term function of meniscus transplants remains questionable because the survivorship rate of the transplants decreases to between 40 and 15 percent at 15 years,” said lead study author Frank Noyes, MD. “Patients should be advised that this procedure is not curative in the long-term and additional surgery will most likely be necessary.”

In another recent study, a team of Danish researchers evaluated nine randomized controlled trials that tracked the benefits and risks of arthroscopic knee surgery and could find “no significant benefit on physical function” as a result of the procedure. Overall, the research team concluded that “these findings do not support the practice of arthroscopic surgery for middle-aged or older patients with knee pain with or without signs of osteoarthritis.”

I had my right knee “scoped” back in 1998, after messing it up playing basketball. It works okay all these years later — a little creaky when I try to do too much, but about what you’d expect for a joint that’s been supporting me for nearly 64 years. But I can’t help wondering whether having the surgeon drill in there and trim out all that damaged meniscus really made that much of a difference.

Knee replacement is another matter altogether, of course. And according to this recent piece in Next Avenue, there’s a lot about this procedure that should give one pause:

Infection risks. Your new knee is made out of metal, which cannot fight an infection if one should crop up after surgery — even years later. The only option is to cut you back open and pull out the mechanism. “We’re finding that many patients are getting late infections,” said Brett Levine, MD, a hip and knee reconstruction and replacement specialist. “They’re diabetic and overweight, and they’re not thinking about the joint. A joint replacement doesn’t have blood supply — antibiotics don’t get to it. You’ll often need an operation to fix the infection.”

They don’t last forever. Typically, a replaced knee will last only about 15 years. And during that time, you’ll need to stay in touch with your doctor and get regular check-ups to make sure the new joint isn’t wearing out. “If you wait 10 to 12 years before seeing a specialist, instead of changing out one part, you might have to replace the whole thing,” said Levine. “You lose that window.”

You won’t rediscover your youthful mobility. There’s a temptation to assume that replacing your bum knee will allow you to do what you were able to do before your knee went bum on you, but that’s not how it works. “It’s a lifestyle change,” Levine said. “Once you get a replacement, running, jumping and high-impact activities are limited, if not cut out, to optimize the length of time a replacement will last. If you push to do your old activities too quickly, you will stress the wound.”

At our age, there’s plenty of stress on the old joints. It comes with the geezer territory. What MLW has taught me, I guess, is that living with it is not a bad option at all.

Craig Cox , an Experience Life deputy editor, explores the joys and challenges of aging well.

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